Efficacy of First MTPJ Arthrodesis as a Treatment in Hallux Rigidus

Inclusion criteria

• Age 40 years or over
• Diagnosis of hallux rigidus: Persistent pain on movement of the first MTPJ AND Osteoarthritic first MTPJ in plain X-rays
• Duration of symptoms ≥1 year
• Pain-NRS during walking of 4 or more on a scale 0-10 (higher is worse)
• No substantial pain in other joints of the foot in clinical examination
• Willingness to accept both treatment options
• Ability to understand trial information and answer outcome assessments in Finnish
• Signed informed consent

Exclusion criteria

• ASA* physical status classification level III or higher
• Patients with weak co-operation (dementia, schizophrenia, etc.)
• Patients with neuropathy, i.e. unable to feel 10g monofilament pressure in less than 8 out of 10 standard testing sites
• Active bacterial infection or ulcer of the lower limb
• Diabetes mellitus with insulin treatment
• Diabetes mellitus and GHb-A1C >64 mmol/mol (regardless of treatment)
• History of rheumatoid arthritis, gout or other inflammatory arthritis of the foot
• Hallux valgus angle >15° in weight-bearing X-ray
• Hallux varus in weight-bearing X-ray
• Large bone cysts in X-ray probably requiring bone grafting in surgery
• Pain in passive manipulation of ipsilateral first toe IP joint
• Patients with severe circulatory disorder of the lower limb: absence of palpable pulses in the foot (both dorsalis pedis artery and tibialis posterior artery)
• History of surgery of the foot in question
• Neuropathic pain of the foot in question (i.e., use of neuropathic analgesics)
• Activity limiting symptoms from an earlier fracture or ligament injury of the foot
• Patient is not willing to accept the operation within the planned time limits (3 to 12 weeks post-randomisation)